Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies

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Summary

Background:

Many people use complementary or alternative medicine (CAM). It is estimated that over 50% of patients that require health care use CAM either in conjunction with, or separate from, conventional health care. Despite the popular use of CAM, patients do not always inform their conventional medicine health carers of their CAM use. The medical practitioner is in most cases the first health care professional a person contacts concerning a health care matter, and needs to have a full history of a health problem to understand and provide optimum care. This literature review aims to provide an understanding of the degree to which patients disclose their use of CAM to their medical practitioners, and their reasons for not doing so.

Method:

A comprehensive literature search identified 12 studies published between 1993 and 2002 that examined what percentage of consumers did not disclose to their medical practitioners their use of CAM, and their reasons for not doing so.

Results:

The rate of non-disclosure of those using CAM is as high as 77% in some studies. The main reasons patients provided for not disclosing their use of CAM to their medical practitioners were concerns about a negative response by the practitioners, the belief that the practitioner did not need to know about their CAM use, and the fact that the practitioner did not ask.

Discussion:

The pre-conceptions patients have that influence their non-disclosure may be based on three issues. First, beliefs and concerns that influence their decision-making, second personal experiences in their consultations with medical practitioners, and third, the desire for more control over their health care. Medical practitioners need to acknowledge the concerns and beliefs of patients in making their health care decisions, and work with patients so that the use of CAM is acknowledged and the patients’ needs, beliefs and concerns respected.

Section snippets

Background

Studies on the use of complementary and alternative medicine (CAM) throughout the Western world have documented that people use CAM either in addition to, or instead of, seeing a medical practitioner.1, 2, 3 These studies have considered CAM use from various perspectives including regional trends, sociodemographic predictors, chronic illnesses, use by ethnic groups, and use by children.4

The studies revealed that not all people communicate their use of CAM with their medical practitioner when

Methods

An international literature search was conducted on the terms ‘complementary medicine’, ‘complementary therapies’, ‘alternative medicine’ and ‘alternative therapies’. An individual search was also conducted on 38 individual therapies, including those most well-known such as Acupuncture, Chiropractic, Homeopathy and Naturopathy. These were drawn from two major texts on Complementary and Alternative Therapies.7, 8 Databases searched were Medline, Cinahl, Sociofile and Psycinfo, and searching

Results

Table 1 gives an overview of the methodologies used in the 12 selected articles. Most of the studies included in this review were cross-sectional and used either convenience or consecutive sampling of patients attending medical clinics as the basis for the investigation. Four studies focussed on use by cancer patients, three on patients with other ailments, and three on use by general clinic patients. Four studies focussed on women, and one on men. Only one study was a general population study

Discussion

This review of 12 research studies has found non-disclosure rates of 23–72%. This wide variation may be attributed to difference in study design. There is variance in patient populations, such as differences in gender and sampling frames, and the definitions and types of CAM included in the study. Adler, for instance, gives no indication of specific therapies being referred to, defining complementary and alternative medicine as “all health care resources to which people have recourse other than

Conclusion

A review of 12 research studies into patient communication of CAM use to their medical practitioner has found non-disclosure rates of 23–72%, and three main reasons for non-disclosure. These are concern about a negative response from the medical practitioner, the fact that the medical practitioner does not ask, and the perception that because medical practitioners work within a biomedical framework they have no knowledge of CAM.

Medical practitioners need to understand the beliefs and concerns

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